Narcotic/opiate detox/withdrawl in the neonate

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    I'm interested in the observations of anyone who has worked with infants being weaned off of therapeutic pain medications rather than illicit drugs (heroin, "illegally" obtained opiates).

    This is a completely hypothetical situation that evolved during a conversation with another nurse, about the advancements in the treating of chronic pain over the last few years. It is something neither of us have encountered or even heard of but we know it has to exist.

    The situation we have in mind involves a mother with a serious medical condition who requires the use of sustained release pain meds and was unable to wean off during the pregnancy. To keep it simple we are assuming the mother had good prenatal care and diet, no smoking, alcohol or illegal drugs and pain medication(s) were taken as prescribed.

    Are there established protocols for these infants?
    If so, do they differ from those for babies born addicted to illicit opiates?

    Is the drug used for weaning the same one they were exposed to (ex: fentanyl, MS, oxy/hydrocodone)?

    How is the starting dosage determined?

    In your opinion do these babies tolerate the process better or worse than babies exposed illicit opiates?

    In your opinion do these babies seem to have more or less complications than babies exposed to illicit opiates?

    In your opinion does the withdrawl/detox process seem "easier" on the baby with some drugs over others?
    Last edit by kids on May 20, '06
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  3. 6 Comments so far...

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    We have had two of these situations recently where Mom was on meds for chronic pain (one on codeine, one on methadone). Overall, we don't get very many drug-exposed infants and what we see is Meth. I haven't even seen a cocaine-exposed infant in years. Haven't seen Heroin in decades, so take what I have to say with that in mind.

    Are there established protocols for these infants?
    If so, do they differ from those for babies born addicted to illicit opiates?


    We use the same protocol and abstinence scoring method no matter what the drug, legal or otherwise.

    Is the drug used for weaning the same one they were exposed to (ex: fentanyl, MS, oxy/hydrocodone)?

    We use Morphine (usually oral, but IV to begin with until on full feeds).

    How is the starting dosage determined?

    As with just about all of our meds, the dose is based the recomended dose in NeoFax (mg/kg/day). It is then adjusted up or down depending on the abstinence score.

    In your opinion do these babies tolerate the process better or worse than babies exposed illicit opiates?

    Addiction is addiction - each baby is different in their response and each drug has different consequences. It also depends on how much mom was using.

    In your opinion do these babies seem to have more or less complications than babies exposed to illicit opiates?

    Same as previous response. The main difference doesn't have to do with withdrawl, but with the family dynamics.

    In your opinion does the withdrawl/detox process seem "easier" on the baby with some drugs over others?

    Methadone and Methamphetamine seem to be pretty bad. since I haven't seen cocaine or heroin in a long time, I can't be much help with this one.

    nell
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    We have had a few recently test + for hydrocodone, and we have specific policies for the protocol to treat.
    Interestingly, we had a baby go through withdrawal for wellbutrin...no tx was given, only comfort care.
    All in all, these babies are pretty darn miserable/irritable - no matter what the med.
    Jenny
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    Like the previous poster, we treat legal and illegal drug withdrawal with the same protocol (abstinence scoring, non-pharmacological management and pharmacological management). This type of baby should be in the quietest area possible, allowed a pacifier, swaddled, etc. We use morphine or methadone. I prefer methadone. IMO it works much better. The only thing that really matters is that you use an opioid to treat opioid withdrawal. Some nurses seem to think versed or ativan treat withdrawal and they don't. We get the baby off the methadone by spacing out the meds (q4h, then q6h, then q8h, etc) first then decreasing the dose. Cutting the dose first instead of spacing out the meds is nasty IMO unless you are decreasing the doses by very small amounts.

    I have some fairly strong opinions on this matter because my first hospital dealt with withdrawal SO often (they actually have an entire L&D/PP ward for chemically dependent women) that they were awesome at it. When I changed hospitals I was horrified by how undertreated withdrawal was. The nurses I worked with often underscored the babies on the abstinence scoring tools so they wouldn't give the PRN med. Of course in report they would talk about the baby being excessively irritabe, sweaty, febrile, not tolerating feeds, having loose watery stools, not sleeping between meals but then tell me the abstinence scores were always less than 3... In that hospital I think it was best if the med was scheduled rather than PRN.

    I do think babies born to mothers using legal prescription meds as they were prescribed fare better in general, but that has more to do with prenatal care and lifestyle than the type of med. I've worked with lots of drug babies born to mothers with diseases like sickle cell who used narcotics.
    Last edit by fergus51 on May 25, '06
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    We are pretty much the same...illicit vs prescription, no difference. We just switched to MSO4 but I agree...Methadone works much better. We have one really bad kid right now that is scoring pretty high...poor kid...and our poor ears LOL We have her in the back corner, dark, swaddled, in an isolette and pacifier in place. When we can get to her we plunk her in a swing and set it on high...it calms her a lot! She is a horrible eater/puker and is so bad

    We have had some kids with the moms on antidepressent therapy we have had to detox...2 of them were Paxil and the kids seized when coming off...that was scary! We had one Lupus mom also that was on tons of meds and we detoxed her kids too. I feel so bad for the babes and their moms...they feel so bad and guilty.
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    Our babies are usually treated the same, we start Abstinence Scoring, then if needed, they go on methodone. It's so sad to see these babies, irritable, difficult to comfort, upset stomachs, spitty, then they get the WORST sore butts. The moms on meds for chronic pain don't seem to understand what they have done to their babies. Of course, they can breast feed, and continue to medicate their babies.......even though it helps with withdrawal, I don't think it can be good for a baby.
  9. 0
    Thank you for the replies, we were really at a loss on the management of these liddos.


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